Individual
THOMAS JOHN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 E BROADWAY STE 185-C, LOUISVILLE, KY 40202-3700
(502) 629-5455
(502) 629-4151
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 272-5100
(502) 272-5114
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
43896
KY
208100000X
Physical Medicine & Rehabilitation Physician
MT190022
PA
208100000X
Physical Medicine & Rehabilitation Physician
TP216
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000667398
ANTHEM - NRP
KY
01
—
000052153T
HUMANA - NRP
KY
01
—
116470
SIHO - NRP
KY
05
—
201016740
—
IN
01
—
50029614
PASSPORT & PASSPORT ADVTG - NRP
KY
05
—
7100129640
—
KY
01
—
9608821
CIGNA - NRP
KY
01
—
P00948781
RAILROAD MEDICARE KENTUCKY
KY
Enumeration date
07/30/2007
Last updated
12/15/2021
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